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Overview

HEALTH SERVICES: POLICY AND SYSTEMS FOR THERAPISTS, 2/e has been completely revised and equips occupational and physical therapists with the foundations for understanding the rapidly and continually evolving developments in private and public health policy that shape their professions. The text explains the principles and major structures of health services, provides an overview of how policies and systems affect the ability to serve patients, and details ways to be an effective advocate during private and public policy change. Readers will explore issues such as access, cost, and quality, as well as regulation basics including public health, licensure, informed consent, and medical liability.

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Policy makes a difference. Each day, occupational therapists and physical therapists alleviate pain, prevent and treat conditions, and improve the functioning of people with temporary or permanent disabilities. Therapists examine, evaluate, diagnose, establish goals, plan, and implement interventions to improve the lives of those they serve. All of this professional activity is supported by policies and systems that define what therapists do and provide the resources to get the job done.

This book is about policy and practice. Policy is not only for administrators and politicians. Policy is for all therapists. If you are a new practitioner, a measure of your effectiveness will be your understanding of the system in which you work and how you professionally socialize yourself within it. As an experienced therapist, one measure of your effectiveness will be your understanding of how you can help your patients receive affordable, necessary services when they need them. As an expert practitioner or administrator, one measure of your effectiveness is to anticipate policy change and proactively make effective choices to advance the quality of care in your work group.

The changes in health care during the 1990s were enormous. Managed care contracting, consolidation and mergers of health care providers, slow growth of government spending on health care, growing disparities between the health of different segments of the population, and the large number of uninsured or underinsured persons reflect some of these momentous events in American health care. For occupational therapists and physical therapists, the 1990s brought significant change, including weakened demand for therapists in traditional settings, the closing and restructuring of outpatient and long-term care businesses, increasing documentation requirements, and increased attention to therapist fraud and abuse of insurance programs. The working environment of therapists is significantly different in 2002 than it was in 1992. But for all of the turmoil and change, we believe that the outlook for the professions of physical therapy and occupational therapy remains positive. The population of Americans who will be retiring and experiencing disablement and need for rehabilitation services will mushroom in the next decade. Advances in medical research (e.g., gene therapy) promise new treatments for conditions that today are fatal. With these new treatments that extend life will come a new demand for improved quality of life for a growing population of persons with disabilities. The development of new practice opportunities in fitness centers and wellness clinics provides new growth potential for the rehabilitation professions. While these changes and others bode well for the long-term future of the rehabilitation professions, the achievement of success will require hard work and an understanding of policy, systems, and advocacy.

This book is about helping therapists to understand the forces and policies that shape the future of health care for people with disabilities. In order to survive and excel in the future health care environment, occupational therapists and physical therapists will need to understand the effect of policy on their work and advocate for the changes necessary to reduce or eliminate their disabling conditions of their patients/clients. Physical therapy and occupational therapy exist for a social purpose: namely, to address the problems created by disablement and to assist patients/clients to self-directed and more complete independence and participation in society. We believe that it is imperative for occupational therapists and physical therapists to understand the policies that support their professions so that they can effectively advocate for their patients and clients to reduce disablement and fulfill the societal purpose of their professions.

The idea for this book originated in courses for physical therapists and occupational therapists at Creighton University on health services, including health care policy, disability policy, and rehabilitation care systems. This book is not a substitute for the content taught in a traditional administration or management course. Rather, it is a complement to the textbooks and courses in this area. The intent of this book is to support the development and implementation of similar courses in other entry-level professional curricula and to stimulate faculty scholarship in this area.

We encourage the flexible use of this book in professional curricula. We recognize that a health services course is not included in many entry-level curricula and that these issues are often covered in a variety of courses, such as professional issues and seminars. We encourage faculty to make maximal use of the information contained in the book that can be easily incorporated into existing courses of study. Obviously, we hope that this book will stimulate faculty to offer a health services course in their curriculum. We believe that this content is important information for entry-level practitioners in both professions. We also hope that the book will inform policymakers and analysts of the issues facing people with disabilities and the rehabilitation therapists who daily work to improve their lives.

We have designed the book for maximal interest and use by both physical therapists and occupational therapists. There is content overlap between the professions, but we recognize that some content areas will not be appropriate for one or the other field (see, for example, Chapter 13). We also believe that this book will be very useful for practicing clinicians who would like to understand the policies, forces, and issues affecting their practice. Many of us have learned most of this information "on the job" and have yearned for a comprehensive textbook covering the basic information about the environments where we work and interact with patients. We hope that we have organized the book in a manner that will facilitate the user's understanding of the content in an efficient and effective manner.

The book is divided into four parts. Part I introduces and explores the fundamental principles of health policy and disability policy. Chapter 1 discusses the basic political concepts that drive policymaking, several conceptualizations of disablement, and how different views of disablement and politics have affected the policies and systems that therapists experience each day. Chapters 2, 3, and 4 address the fundamental concepts of health policy; access, cost, and quality. Chapter 5 concludes the first section of the book by explaining public policies that address social disability.

Part II focuses on the financing and reimbursement of health care, specifically physical therapy and occupational therapy services. Insurance and managed care (Chapters 6 and 7), Medicare (Chapter 8), Medicaid and veterans affairs health care programs (Chapter 9) are all introduced. Policies that finance therapy services are among the most potent forces that shape and direct contemporary practice on a daily basis for all therapists.

Part III of the book examines the structure and organization of the health care system that delivers therapy services. The acute health care and post-acute health care systems (Chapters 10 and 11) have developed in response to policy decisions and community needs for treatment of illness, injury, and chronic disease. Chapter 12 discusses the types and roles of the practitioners who work in this health care system and with whom occupational therapists and physical therapists interact on a regular basis. Chapter 13 introduces the mental health care system, an important site for occupational therapy services. Part III concludes with a chapter on public health (Chapter 14).

Part IV concludes the book with a chapter on advocacy. This chapter provides information on policy formation and how therapists can be active now and in the future, in ensuring effective policy for therapy services for persons with disabilities. We have included a glossary of all of the key words that are introduced at the beginning of each chapter.

We welcome comments, suggestions, and criticisms from our readers. Policy is a "contact sport." Improvements in this textbook will come from the people who read and utilize it. We encourage you to contact us (and to get involved in policy), and we look forward to considering and responding to your input as the book is utilized.

Preface

Policy makes a difference. Each day, occupational therapists and physical therapists alleviate pain, prevent and treat conditions, and improve the functioning of people with temporary or permanent disabilities. Therapists examine, evaluate, diagnose, establish goals, plan, and implement interventions to improve the lives of those they serve. All of this professional activity is supported by policies and systems that define what therapists do and provide the resources to get the job done.

This book is about policy and practice. Policy is not only for administrators and politicians. Policy is for all therapists. If you are a new practitioner, a measure of your effectiveness will be your understanding of the system in which you work and how you professionally socialize yourself within it. As an experienced therapist, one measure of your effectiveness will be your understanding of how you can help your patients receive affordable, necessary services when they need them. As an expert practitioner or administrator, one measure of your effectiveness is to anticipate policy change and proactively make effective choices to advance the quality of care in your work group.

The changes in health care during the 1990s were enormous. Managed care contracting, consolidation and mergers of health care providers, slow growth of government spending on health care, growing disparities between the health of different segments of the population, and the large number of uninsured or underinsured persons reflect some of these momentous events in American health care. For occupational therapists and physical therapists, the 1990s brought significant change, including weakened demand for therapists intraditional settings, the closing and restructuring of outpatient and long-term care businesses, increasing documentation requirements, and increased attention to therapist fraud and abuse of insurance programs. The working environment of therapists is significantly different in 2002 than it was in 1992. But for all of the turmoil and change, we believe that the outlook for the professions of physical therapy and occupational therapy remains positive. The population of Americans who will be retiring and experiencing disablement and need for rehabilitation services will mushroom in the next decade. Advances in medical research (e.g., gene therapy) promise new treatments for conditions that today are fatal. With these new treatments that extend life will come a new demand for improved quality of life for a growing population of persons with disabilities. The development of new practice opportunities in fitness centers and wellness clinics provides new growth potential for the rehabilitation professions. While these changes and others bode well for the long-term future of the rehabilitation professions, the achievement of success will require hard work and an understanding of policy, systems, and advocacy.

This book is about helping therapists to understand the forces and policies that shape the future of health care for people with disabilities. In order to survive and excel in the future health care environment, occupational therapists and physical therapists will need to understand the effect of policy on their work and advocate for the changes necessary to reduce or eliminate their disabling conditions of their patients/clients. Physical therapy and occupational therapy exist for a social purpose: namely, to address the problems created by disablement and to assist patients/clients to self-directed and more complete independence and participation in society. We believe that it is imperative for occupational therapists and physical therapists to understand the policies that support their professions so that they can effectively advocate for their patients and clients to reduce disablement and fulfill the societal purpose of their professions.

The idea for this book originated in courses for physical therapists and occupational therapists at Creighton University on health services, including health care policy, disability policy, and rehabilitation care systems. This book is not a substitute for the content taught in a traditional administration or management course. Rather, it is a complement to the textbooks and courses in this area. The intent of this book is to support the development and implementation of similar courses in other entry-level professional curricula and to stimulate faculty scholarship in this area.

We encourage the flexible use of this book in professional curricula. We recognize that a health services course is not included in many entry-level curricula and that these issues are often covered in a variety of courses, such as professional issues and seminars. We encourage faculty to make maximal use of the information contained in the book that can be easily incorporated into existing courses of study. Obviously, we hope that this book will stimulate faculty to offer a health services course in their curriculum. We believe that this content is important information for entry-level practitioners in both professions. We also hope that the book will inform policymakers and analysts of the issues facing people with disabilities and the rehabilitation therapists who daily work to improve their lives.

We have designed the book for maximal interest and use by both physical therapists and occupational therapists. There is content overlap between the professions, but we recognize that some content areas will not be appropriate for one or the other field (see, for example, Chapter 13). We also believe that this book will be very useful for practicing clinicians who would like to understand the policies, forces, and issues affecting their practice. Many of us have learned most of this information "on the job" and have yearned for a comprehensive textbook covering the basic information about the environments where we work and interact with patients. We hope that we have organized the book in a manner that will facilitate the user's understanding of the content in an efficient and effective manner.

The book is divided into four parts. Part I introduces and explores the fundamental principles of health policy and disability policy. Chapter 1 discusses the basic political concepts that drive policymaking, several conceptualizations of disablement, and how different views of disablement and politics have affected the policies and systems that therapists experience each day. Chapters 2, 3, and 4 address the fundamental concepts of health policy; access, cost, and quality. Chapter 5 concludes the first section of the book by explaining public policies that address social disability.

Part II focuses on the financing and reimbursement of health care, specifically physical therapy and occupational therapy services. Insurance and managed care (Chapters 6 and 7), Medicare (Chapter 8), Medicaid and veterans affairs health care programs (Chapter 9) are all introduced. Policies that finance therapy services are among the most potent forces that shape and direct contemporary practice on a daily basis for all therapists.

Part III of the book examines the structure and organization of the health care system that delivers therapy services. The acute health care and post-acute health care systems (Chapters 10 and 11) have developed in response to policy decisions and community needs for treatment of illness, injury, and chronic disease. Chapter 12 discusses the types and roles of the practitioners who work in this health care system and with whom occupational therapists and physical therapists interact on a regular basis. Chapter 13 introduces the mental health care system, an important site for occupational therapy services. Part III concludes with a chapter on public health (Chapter 14).

Part IV concludes the book with a chapter on advocacy. This chapter provides information on policy formation and how therapists can be active now and in the future, in ensuring effective policy for therapy services for persons with disabilities. We have included a glossary of all of the key words that are introduced at the beginning of each chapter.

We welcome comments, suggestions, and criticisms from our readers. Policy is a "contact sport." Improvements in this textbook will come from the people who read and utilize it. We encourage you to contact us (and to get involved in policy), and we look forward to considering and responding to your input as the book is utilized.

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